[Multifocal brain lesions]. / Mnogoochagovye porazheniya golovnogo mozga.

Despite the current laboratory and instrumental approaches to the diagnosis, a patient with multiple brain lesions remains a difficult one. The reason is that these lesions can be caused by a variety of disorders, including rare ones and atypical forms. Distinguishing neoplastic lesions from non-neoplastic CNS disorders is crucial due to different treatment options. The authors report the case of a patient with multiple brain lesions, present a literature review of diseases to be differentially diagnosed with multifocal brain lesions and suggest a simple algorithm for the differential diagnosis. Timely clinical evaluation and a multidisciplinary approach are required for making a definitive diagnosis that is extremely important to start the appropriate therapy.

[Topical respiratory strategies in neurocritical care]. / Aktual'nye respiratornye strategii v neiroreanimatologii.

Management of the respiratory tract and maintenance of adequate gas exchange are the basic goals of critical care. Injury to the nervous system is often accompanied by development of respiratory disorders. On the other hand, changes in the gas composition of arterial blood can cause brain damage. In addition, approaches to the patient with respiratory failure, which are used in general critical care and neurocritical care, may differ. The presented literature review is devoted to modern respiratory strategies used in neurocritical care.

[Surgery for intractable epilepsy in a patient with encephalocele of the temporal lobe: a case report]. / Khirurgicheskoe lechenie farmakorezistentnoi épilepsii u patsientki s éntsefalotsele visochnoi doli (klinicheskoe nabliudenie i obzor literatury).

We describe a case of surgical treatment of intractable temporal epilepsy in a female patient with congenital middle cranial fossa encephalocele. We present clinical-anamnestic and neuroimaging data as well as the microscopic and macroscopic pictures of encephalocele. We analyze outcomes of surgery for this pathology, which have been reported in the literature. To date, there have been a few articles on this subject in the domestic literature. The development of neuroimaging techniques and a growing number of verified encephalocele cases promote the widespread use of surgery for treatment of intractable epilepsy. Congenital encephalocele should be considered in the differential diagnosis of intractable temporal epilepsy, and, if verified, surgical treatment is the method of choice in most cases.

[Experience of endoscopic removal of hypertensive intracerebral hemorrhage].

AIM: This study was aimed at assessing the efficacy of endoscopic technique in surgery for hypertensive intracerebral hemorrhage. MATERIAL AND METHODS: This paper focus on our experience (11 cases) of endoscopic removal of hypertensive intracerebral hemorrhage. The paper presents examples of endoscopic removal of hematomas located in the basal ganglia (9 cases) and in the posterior fossa (2 cases), causing occlusion at the fourth ventricle. In 3 patients (27%) with intraventricular hemorrhage, the removal of acute hematomas from the ventricular system with simultaneous endoscopic triple ventriculostomy was performed. Intervention was carried out within the first 6 hours in patients with hemispheric hematomas (in 90% of cases) and within 3-5 hours in patients with PCF hematomas. RESULTS: The article analyzes the functional outcomes in the early and late postoperative period. Complete regression of neurological symptoms was achieved in 4 (36%) patients and the remaining 7 (64%) patients had a moderate disability at discharge. CONCLUSION: In our opinion, endoscopic removal of hypertensive intracerebral hemorrhage is a promising method that meets all existing aspects of modern neurosurgery. The combination of rigid and flexible endoscopy provides new capabilities in surgery of patients with intraventricular hemorrhage.

[Endoscopic assistance in microvascular decompression of cranial nerves].

Microvascular decompression (MVD) is an effective method for treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GPN). The aim of this study was to assess the role of endoscopic assistance in MVD for the treatment of cranial neuropathies. Since 2009 till 2011 133 patients with cranial neuropathies were treated by MVD in Burdenko Neurosurgical Institute, Moscow. In 22 patients (11 patients with HFS, 10 patients with TN, 1 with GPN) endoscopic assistance was applied during the MVD. We used minimally invasive retrosigmoid approach in a unilateral position. Cerebellopontine angle was explored by 30-degree or 70-degree telescope to visualize the root entry zone of trigeminal, facial or glossopharyngeal nerves and to locate the neurovascular conflict. In 9 patients with HFS and in 1 patient with TN and in another patient with GPN endoscopy discovered offending vessels that were not visible through the microscope. In all cases endoscope was used to exclude another site of compression and to verify decompression and to identify position of teflon and offending vessel after MVD. Immediately after the surgery excellent outcome was observed in 10 patients with HFS (89%), one patient was reoperated 1.5 years after first operation with positive effect. Relief of pain in early postoperative period was observed in patients with TN and GPN. There were no major complications and postoperative mortality in our series. Endoscopic assistance is very effective and helpful technique in MVD of cranial nerves, especially in cases with HFS. In this study the use of the endoscope allowed to identify the site of compression and to confirm the position of teflon after MVD.

[Identification of the cochlear nerve in surgical removal of vestibular schwannomas].

Review of methods which allow intraoperative identifying and monitoring of cochlear and facial nerves in resection of vestibular schwannomas is presented. We describe a case of successful identification and functional preservation of facial and cochlear nerves in a patient with acoustic neuroma. Detailed description of neurophysiological and neurosurgical aspects of surgical technique intended to preserve auditory functions is given. According to some authors, application of intraoperative neurophysiological techniques in surgery of vestibular schwannomas allows to preserve not only anatomical but also functional integrity of neural structures as well.